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Journal of Surgical Research 114, 187–194 (2003) doi:10.1016/S0022-4804(03)00248-8 HL-1 Myocytes Exhibit PKC and K ATP Channel-Dependent Delta Opioid Preconditioning 1,2 Elisabeth M. Seymour, M.S.,* Shu-Yung James Wu, B.S.,* Melissa A. Kovach, B.S.,* Matthew A. Romano, M.D.,* Jonathan R. Traynor, Ph.D.,† William C. Claycomb, PhD.,‡ and Steven F. Bolling, M.D.* ,3 *Department of Cardiac Surgery, B558 MSRBII 0686 and †Department of Pharmacology, 1301 MSRBIII, University of Michigan Medical School, Ann Arbor, MI, USA; and ‡Department of Biochemistry and Molecular Biology, Louisiana State University Health Sciences Center, New Orleans, LA, USA Submitted for publication December 11, 2002 Background. Opioid preconditioning protects the myocardium against ischemia/reperfusion (IR) injury. By enhancing cardiomyocyte viability, opioids can enhance cardiac function and recovery from IR injury during acute cardiac care. The myocyte model HL-1 is an immortalized, mouse atrial cell line that expresses functional delta-opioid receptors. The HL-1 myocyte may be useful for IR injury research exploring opioid cardioprotection. Materials and methods. In study I, microplates of HL-1 were subjected to 10 min pre-treatment with either basal media, delta-opioid agonist DADLE(10uM), or DADLE(10uM) ⴙ delta-antagonist naltrindole (10uM). Study II treatment groups included PKC inhibitor chelerythrine (2uM), K ATP channel closer glybenclamide (100uM), or mitochondrial K ATP channel opener diazoxide (100uM) administered in various combinations followed by DADLE (10uM) or control. Microplates were subjected to normal oxygen/substrate conditions or ischemic (<1% 0 2) and substrate deficient (10 uM 2-Deoxyglucose versus 10 mM glucose) conditions, then reperfused with normal oxygen and glucose-containing media. Microplate supernatants were subjected to lactate dehydrogenase (LDH) assay. Results. Compared to untreated control, the LDH assay showed significant reduction in opioid-only pretreated groups at all time points. These effects were attenuated with delta-opioid antagonist coadministration. Co-administration of non-selective 1 This was presented at the annual meeting of the Association for Academic Surgery, Boston, MA, November 7–9, 2002. 2 The present study was supported by a grant from the National Institutes of Health-NHLBI, HL58781. 3 2120 Taubman Center, Box 1500 East Medical Center Dr. Ann Arbor, MI 48105-0348. E-mail: [email protected]. K ATP channel closer glybenclamide and DADLE abolished DADLE cytoprotection, while selective mitochondrial K ATP opener diazoxide mimicked DADLE cytoprotection Co-administration of chelerythrine and DADLE significantly reduced chelerythrine cytotoxicity. Conclusion. Delta-opioid preconditioning of HL-1 myocytes significantly decreased necrosis from in vitro simulated ischemia/reperfusion as measured by LDH release; this effect was reversed by delta-antagonist naltrindole. Cytoprotection was PKC and K ATP channeldependent. HL-1 myocytes exhibit opioid-induced cytoprotection from IR injury, and present a novel model of pharmacologic preconditioning. © 2003 Elsevier Inc. All rights reserved. Key Words: opioid; ischemia; reperfusion; necrosis; pre-conditioning. INTRODUCTION Cardiac ischemia/reperfusion injury impairs cardiac function, and can lead to the death of myocytes by both apoptosis and necrosis. Global ischemia, as occurs in cardiac surgical procedures requiring cardiopulmonary bypass, typically induces myocyte necrosis versus apoptosis. In conditions of global ischemia, approximately 90% of myocyte death occurs by necrosis as measured within a few hours of reperfusion [1–3]. Still, apoptosis is postulated to contribute to downstream signals that enhance necrotic death in late reperfusion [4, 5]. The severity of ATP depletion during ischemia partly determines which death pathway a myocyte will under go [6]. Besides ATP depletion, other consequences of ischemia/reperfusion injury include calcium overload, 187 0022-4804/03 $35.00 © 2003 Elsevier Inc. All rights reserved. 188 JOURNAL OF SURGICAL RESEARCH: VOL. 114, NO. 2, OCTOBER 2003 osmotic swelling, contractile dysfunction, and freeradical induced protein and DNA modifications [7]. Ischemic or pharmacologic preconditioning decreases the scope and severity of ischemia/reperfusion injury. Preconditioning involves the attenuated response of a larger ischemic insult by prior exposure to period(s) of cell stress, such as brief cycles of ischemia or heat stress. Pharmacologic preconditioning with opioids has been shown to reduce ischemia/reperfusion damage by limiting infarct size and enhancing functional recovery in whole-heart models [8, 9]. In addition, isolated myocyte models indicate that opioids can enhance cell viability [10 –12] and function [13]. Although the end effectors of acute opioid preconditioning remain elusive, early events following opioidreceptor stimulation are better understood. Opioids agonists act through G i protein-coupled opioid receptors, leading to the translocation and activation of protein kinase C. Active PKC then initiates cardioprotection through multiple kinase pathways which phosphorylate undetermined effectors [8, 14 –16]. Mitochondrial K ATP channels opened by opioid-agonist stimulation also play a critical role in PKC-mediated cardioprotection [17–21]. The temporal relationship between PKC activation and K ATP channel opening continues to be revealed. Once believed to be an effector of opioid preconditioning, recent studies also indicate a trigger role for K ATP openers [21]. Both ventricular and atrial tissue/myocyte studies support opioid cardioprotection against ischemia/ reperfusion injury. Isolated myocyte studies in opioid cardioprotection often use ventricular myocytes, which offer a higher myocyte yield from costly primary isolations. However, atrial tissue has been another important cell source for investigations of opioid cardioprotection. Bell and colleagues found similar mRNA relative abundance profiles for delta, kappa, and mu opioid receptors between human ventricular and atrial tissue [22]. Importantly, both atrial and ventricular tissue cytoprotection is reversible by specific opioid antagonists, PKC inhibitors, and K ATP channel closers such as mitochondrial K ATP antagonist 5-HD or nonspecific K ATP channel closer glybenclamide [18, 21–26]. Our laboratory first characterized the presence of functional delta-opioid receptors on an immortalized mouse atrial cell line, HL-1 [27]. As such, HL-1 cell culture could serve as an alternative cell model for investigations in delta opioid cardioprotection. Immortalized cell culture provides several benefits over primary cell isolations. Primary isolation of ventricular myocytes involves 1) animal use and care, 2) costly and lengthy preparation, 3) variable and limited yield for high-throughput approaches, and a 4) heterogeneous cell population. This study evaluated the effect of opioid preconditioning on the viability of HL-1 myocytes subjected to in vitro ischemia/reperfusion injury. To establish a relationship between HL-1 and established myocyte models of opioid cardioprotection, we also evaluated the PKC and K ATP channel-dependence of the preconditioning mechanism. MATERIALS AND METHODS Chemicals and Reagents HL-1 cardiomyocytes were obtained from their originator, Dr. Willam C. Claycomb, Lousisiana State University Health Sciences Center. Claycomb Media TM was obtained from JRH Biosciences(Lenexa, KS), and fetal bovine serum from Life Technologies/GibcoBRL (Carlsbad, CA). DADLE was a generous gift from Dr. Tsung-Ping Su, NIH-NIDA. All other reagents were purchased from Sigma-Aldrich (St. Louis, MO), and cell-culture disposables from Fisher Scientific (Hanover Park, IL). Diazoxide, chelerythrine, and glybenclamide were purchased from Sigma-Aldrich. All agents were dissolved in DMSO, then diluted in a basic salt solution (BSS) containing (in g/L): 6.7 NaCl, 0.186 KCl, 1.85 NaHCO 3 .0197 MgSO 47H 2O, .120 NaH 2PO 4, .097 CaCl 22H 20, and 1.8 glucose, pH 7.4. The final concentration of DMSO was 0.01% across all treatments. Cell Culture and Pretreatments HL-1 cells were maintained in T-75 flasks for routine passaging, and grown in 48 and 96-well microplates for experimental procedures. Cell culture-ware was pre-coated with 0.00125% fibronectin in 0.02% gelatin. Claycomb Media TM for cell growth and maintenance was supplemented with 0.1 mM norepinephrine (Sigma-Aldrich), 2mM L-glutamine (Life Technologies), 100 U/ml/100ug/ml Penicillin/ Streptomycin (Life Technologies), and 10% fetal bovine serum (JRH Biosciences). Norepinephrine supplementation of Claycomb Media TM allows HL-1s to display a beating phenotype and to maintain their differentiated state [28]. HL-1s were plated at a concentration of 2 ⫻ 10 4 cells/cm 2 into 48-well plates and 96-well plates, and incubated at 37°C in a 5% CO 2 water-jacketed incubator. Experiments were initiated at approximately 80% confluency. For treatment groups, all media was replaced with normoxic, glucose-containing BSS (recipe as detailed earlier). Based upon receptor binding studies and preliminary dose-response (LDH release) curves (data not shown), 10 uM DADLE provided the most cytoprotection from a 10 minute pre-treatment. Study I was designed to determine the cyotprotective ability of delta opioid DADLE pre-conditioning, and the ability of delta-opioid antagonist naltrindole to reverse this protection. Plates were treated for 10 min with either (normoxic, glucose-containing) BSS, BSS ⫹ DADLE (10uM), or BSS ⫹ DADLE (10uM) ⫹ naltrindole (10uM), followed by a 5 min washout with normoxic, glucose containing BSS before to the ischemia/reperfusion protocol. Study II tested the PKC and K ATP channel dependence of DADLE cytoprotection, Parallel treatments are illustrated in Fig. 1. Doses of treatment reagents chelerythrine, glybenclamide, and diazoxide were based upon preliminary studies conducted in our laboratory with HL-1 myocytes, and studies of others using human atrial trebeculae and a ventricular myocyte models [11, 21, 29]. Chelerythrine (CHE 2 uM), glybenclamide (GLYB100 uM), or diazoxide (DIAZ 100 uM) treatments diluted in normoxic, glucose containing BSS were administered alone or in combination for 10 min. Plates were washed twice with PBS, pH 7.4. The washes were immediately followed by 10 min of DADLE or control BSS in designated groups, followed by a 5 min PBS washout prior to the ischemia/reperfusion protocol. Ischemia/Reperfusion Protocol Ischemia was obtained by both substrate and oxygen deprivation. Ischemic BSS (pH 6.8) contained 10 mM 2-deoxyglucose substituted SEYMOUR ET AL.: HL-1 MYOCYTE MODEL OF OPIOID CARDIOPROTECTION 189 FIG. 1. Experimental Design to Assess the Impact of PKC inhibitor and K ATP channel agonists/antagonists on DADLE cardioprotection of HL-1 cells. In a 96-well plate format, 10 uM Opioid DADLE(OP), 2uM (CHE), 100 uM Glybenclamide (GLYB), 100 uM Diazoxide (DIAZ) were administered in the above combinations for 10 min/washout/10 min of OP or control/washout. Plates then subjected to 60 min of simulated ischemia/180 min reperfusion. for 10 mM glucose to limit glycolysis. Ischemic BSS was preequilibrated to limit dissolved oxygen by bubbling with 95%N 2/ 5%CO 2 for 30 min at 37°C. Next, simultaneous, parallel media changes with normoxic and ischemic BSS occurred before placement in a Billups-Rothenburg Modular Incubator Chamber (BillupsRothenburg, Del Mar, CA). The chamber was flushed with 95%N 2/ 5%CO 2 at 20 L/min for 10 min, monitored by an in-line Flow-Meter. Oxygen levels were also monitored in-line using the Qubit Oxygen Sensor (Qubit Systems, Kingston, ON). The hypoxia chamber was then sealed and placed in the 37°C incubator, as was the normoxic control. After 1 h, both normoxic and ischemic plates were removed and exposed to room air. All plates then underwent a media change with fresh, normoxic BSS. Plates were subsequently returned to a 37°C incubator for 180 minute of reperfusion. LDH Assay From 48 (Study I) and 96-well (Study II) microplates, media was collected into microcentrifuge tubes and briefly spun at 200 ⫻ g to remove possible cell debris. Cytoplasmic LDH is released from cells exhibiting a loss of plasma membrane integrity, as typically occurs from primary and secondary necrosis. LDH activity was measured using the CytoTox 96 ® assay (Promega, Madison WI) by the reduction of lactate to pyruvate in the presence of NAD ⫹. The resultant NADH reduces INT, a tetrazolium salt, to form a red formazan product that is detectable at 490 nm. Results were read on a BioTek microplate reader (Bio-Tek, Winooski, VT) and quantified using Delta-Soft3 Software (BioMetallics, Princeton, NJ). Results were normalized to maximal LDH release following treatment with 0.8% Triton X-100 as directed by the manufacturer. Study I timecourse of LDH release was determined by sampling the media at 90, 120, and 180 minutes of reperfusion. Study II LDH release data was obtained only at 180 min of reperfusion. For graphical purposes, data from the LDH release was further transformed as % untreated control. Re- sults were pooled from four separate experiments and expressed and mean ⫾ SEM. Statistical analysis was performed using the paired t test, with P ⬍ 0.05 considered significant. RESULTS AND DISCUSSION LDH/Necrosis Measures Study I time-course data from opioid-preconditioned HL-ls reveal a consistent and statistically significant decrease in necrosis at various points of reperfusion (Fig. 2). More importantly, this effect is reversed by delta-opioid antagonist naltrindole co-administration. This data supports previous findings in primary ventricular myocytes showing reduced necrosis from opioid preconditioning [10, 30]. Studies using whole heart and primary atrial/ ventricular models indicate that opioid-preconditioning manifests in PKC activation, and that PKC inhibition limits or abolishes cardioprotection. In addition, the preconditioning pathway of PKC phosphorylationmediated K ATP channel opening is well documented in several species. To assess the utility of HL-ls as a model of opioid preconditioning, we evaluated the impact of PKC inhibitor chelerythrine (CHE), nonselective K ATP channel closer glybenclamide (GLYB), and mitochondrial K ATP channel opener diazoxide (DIAZ) (Fig. 1). Study II findings shown in Figs. 3–5 indicate that 190 JOURNAL OF SURGICAL RESEARCH: VOL. 114, NO. 2, OCTOBER 2003 FIG. 2. Timecourse of LDH Necrosis Measures during Reperfusion of delta-opioid agonist/antagonist treated HL-1 Myocytes. Cells were pretreated with control media, 10uM DADLE(OP), or 10 uM DADLE ⫹ 10 uM antagonist naltrindole (ANT) for 10 min, followed by a 5 min washout, then 60 min of simulated ischemia/180 min reperfusion. Media sampled at 90, 120, and 180 min of reperfusion. N ⫽ 9 in each group, presented as % of untreated control. Paired t-test versus untreated control raw O.D.**P ⬍ 0.0001, * P ⬍ 0.01. DADLE(OP) cardioprotection in HL-1 involves PKC activity. As shown in Fig. 3, OP-only pre-treatment significantly decreased necrosis by 44% versus ischemic control (P ⬍ 0.05). In contrast, pre-incubation with PKC inhibitor CHE significantly increased necrosis over untreated ischemic control (70% increase). However, CHE/OP co-administration decreased death by approximately 40% as compared to CHE-only treat- ment. Therefore, the known PKC agonist activity of opioid pretreatment appeared to counter the PKC antagonism of CHE, reflected in enhanced cytoprotection. K ATP channel closer results also reflect findings in FIG. 3. Chelerythrine Inhibition of delta-opioid HL-1 myocyte cardioprotection. 10 uM DADLE(OP) or 2 uM (CHE) were administered for 10 min followed by washout before 60 min simulated ischemia followed by 180 min reperfusion. Additional CHE/OP group consisted of 10 min CHE/washout/10 min OP/washout, followed by ischemia/reperfusion. Data expressed as % Maximum LDH release accomplished by Triton X-100. N ⫽ 4 for each treatment. Paired t-test as compared to ischemic (untreated) control. *P ⬍ 0.05, **P ⬍ 0.0001. Paired t-test comparing CHE and CHE/OP depicted as †P ⬍ 0.01. FIG. 4. Glybenclamide Inhibition of delta-opioid HL-1 myocyte cardioprotection. 10 uM DADLE(OP) or 100 uM (GLYB) were administered for 10 min each followed by washout before 60 min simulated ischemia followed by 180 min reperfusion. Additional CHE/GLYB group consisted of 10 min CHE/10 min GLYB/washout, followed by ischemia/reperfusion. Data expressed as % Maximum LDH release accomplished by Triton X-100. N ⫽ 4 for each group. Students t-test as compared to ischemic(untreated) control. *P ⬍ 0.05, **P ⬍ 0.0001. Paired t-test comparing CHE, CHE/GLB-OP versus CHE/OP depicted as †P ⬍ 0.01. SEYMOUR ET AL.: HL-1 MYOCYTE MODEL OF OPIOID CARDIOPROTECTION FIG. 5. Diazoxide Mimics delta-opioid HL-1 myocyte cardioprotection. 10 uM DADLE(OP) or 100 uM (DIAZ) were administered for 10 min each followed by washout before 60 min simulated ischemia followed by 180 min reperfusion. Additional CHE/DIAZ group consisted of 10 min CHE/10 min DIAZ/washout, followed by ischemia/ reperfusion. Data expressed as % Maximum LDH release accomplished by Triton X-100. N ⫽ 4 for each group. Students t-test as compared to ischemic (untreated) control. *P ⬍ 0.05, **P ⬍ 0.0001. Paired t-test comparing CHE and CHE/DIAZ-OP depicted as †P ⫽ 0.01. primary ventricular myocyte models and isolated heart models. As shown in the GLYB-only group in Fig. 4, K ATP channel antagonism alone was not cytotoxic versus untreated ischemic control, which supports findings in whole heart using non-selective K ATP channel closer GLYB [31] and selective, mitochondrial K ATP closer 5-hydroxydecanoate (5-HD) [32–35]. Yet, pretreatment of HL-1 with GLYB eliminated the benefit of subsequent OP administration, and GLYB-OP resembled ischemic control. This result indicates that DADLE cytoprotection of HL-1 myocytes is K ATP channel dependent. Although the most deleterious combination, CHE/GLYB-OP was not significantly cytotoxic versus CHE alone, indicating that relative to the impact of GLYB, PKC antagonism was largely responsible for cytotoxicity. Figure 5 shows that the selective MitoK ATP channel opener DIAZ closely mimicked OP-only treatment reduced cytotoxicity, which supports the importance of the MitoK ATP channel in HL-1 opioid cytoprotection. Cytoprotection from DIAZ is well documented in both ischemic and pharmacologic preconditioning studies [11, 36], though DIAZ has been shown to also open SarcK ATP in conditions of high ADP levels, as occurs during severe or prolonged ischemia [37]. The relative cardioprotective contributions of sarcolemmal and mitochondrial K ATP channel opening continue to be revealed. The consequences of Sarc/Mito channel opening impact different measures of cardioprotection. MitoK ATP opening primarily affects mitochondrial integ- 191 rity and aerobic capacity during reperfusion, and contributes to redox signaling mechanisms of cardioprotection [38]. SarcK ATP channel increases potassium efflux from the cell, hastening repolarization and shortening action potential duration [39]. Hyperpolarization reduces Ca 2⫹ entry through the L-type calcium channel, reducing Ca 2⫹ overload and protecting osmotic balance. However, opening of the sarcolemmal K ATP channel may also promote opening of the mitochondrial channel. As demonstrated by Waring, hyperpolarization by SarcK ATP channel opening may trigger increased phospholipase D activity [40]. Phospholipase D activity is proposed to contribute to pre-conditioning [41, 42] by increasing diacyl-glycerol formation and PKC activation, which phosphorylates and accelerates MitoK ATP channel opening [43]. The results of the current study do not differentiate the relative contribution of the mitochondrial versus sarcolemmal K ATP channel. The cytoprotective impact of K ATP channel openers may depend upon oxygen conditions and the model employed. Though diazoxide shows a 2000-fold preference for the MitoK ATP channel in normal oxygen conditions [44], this preference is reduced in ischemic conditions and permits the opening of SarcK ATP channels. In isolated hearts undergoing ischemia/reperfusion, Tanno demonstrated that selective SarcK ATP channel blockers were able to attenuate, though not abolish the infarct reducing effect of diazoxide [45]. This result suggests that diazoxide had opened both MitoK ATP and SarcK ATP, and that SarcK ATP opening contributed to cytoprotection. However, in the isolated myocyte model, Sato et al. showed that the cytoprotective benefits of diazoxide were independent of SarcK ATP status [46]. Further investigations of our group are underway to ascertain the HL-1 preconditioning impact of both channel types, by using specific SarcK ATP closer HMR 1098 and MitoK ATP closer 5-HD. Interestingly, the benefits of OP and DIAZ mediated K ATP opening were not additive. As shown in Fig. 5, DIAZ/OP combination increased death versus either agent alone, so that DIAZ/OP resembled untreated control. Supportive work by Liu, Marban, Kowaltkowski, and Garlid has shown that excessive opening of mitochondrial K ATP channels leads to increased mitochondrial membrane potential, reduced reperfusion aerobic respiration capacity, and increased mitochondrial calcium uptake [47], concluding with mitochondrial osmotic swelling and cell death [48]. However, in the CHE/DIAZ-OP group, the addition of DIAZ-OP reduced death by approximately 53% as compared to CHE alone. The current data demonstrate that the addition of mitochondrial K ATP openers(DIAZ or OP) downstream of PKC partly counters the toxic effects of PKC antagonism by CHE. Therefore, PKC activation appears to be an essential upstream event in HL-1 opioid pre-conditioning. 192 JOURNAL OF SURGICAL RESEARCH: VOL. 114, NO. 2, OCTOBER 2003 Collectively, our LDH assay results indicate that in the HL-1 cultured myocyte model, delta-opioid preconditioning enhanced viability in a PKC and K ATPchannel dependent manner. HL-1 opioid cytoprotection appears to be exclusively enacted through the deltaopioid receptor. Previous work by our group [27] used saturation binding and competition binding assays to determine the presence of delta-receptor binding on HL-1 membranes (using DADLE, DPDPE, reversible by naltrindole), and to demonstrate the lack of selective mu- and kappa-receptor binding (using DAMGO, CTAP, and U69,593). Furthermore, HL-1 demonstrated broad stimulation delta-opioid mediated ( 35S)GTP␥S binding, with an efficacy ranking of DADLE ⬎ SNC80 ⬎ DPDPE ⬎ DSLET ⬎ deltorphin II at a 10 uM concentration, the concentration used in this study. DADLE cytoprotection occurs at doses from 10 uM to 10 pM (data not shown), however, the higher dose was used in the current study due to previously confirmed 10 uM and 1 uM DADLE stimulation of GTP␥S binding (⫹26.6% and ⫹18.4% above control, respectively). The results of the current study indicate that HL-1 opioid cardioprotection is accomplished through similar pathways of other primary isolate myocyte preconditioning models, including rat [11, 36], chicken [12, 49], rabbit [16, 50 –52], pig [53–55], and human [18, 21, 22]. Primary Myocyte Culture versus HL-1 Cell Culture The use of an immortalized cell line has several advantages over primary isolates. Primary isolations of ventricular myocytes inevitably yield heterogeneous cell populations, including fibroblasts, endothelial cells, and leukocytes [56]. Attempts to promote cellular homogeneity include the use of fibroblast inhibitors, differential gradients during isolation, and pre-plating methods to selectively remove fibroblasts. Immunological detection of myocyte-specific markers is required to verify their percentage among the isolated cells [57]. Viability and resilience of the isolated myocytes is dependent upon the isolation procedure, species, and age of animal utilized. In addition to variable yields, primary cell isolation depletes myocytes of the endogenous antioxidant reduced glutathione (GSH), rendering them susceptible to oxidative injury. Reiners and colleagues showed that adherent monolayer cultures exposed to trypsin digestion required approximately 24 h to recover basal levels of reduced glutathione [58], which were decreased by 40 –95% from standard passaging techniques. Because the isolation of primary myocytes from whole heart requires considerable mechanical manipulation and enzymatic digestion, one can speculate that the GSH loss in viable cells would be similar if not elevated from adherent cell passaging techniques. The depleted antioxidant reserve would likely impact the results of preconditioning mechanisms that rely, in part, on redox signaling. Under this consideration, investigations affected by free radical dynamics must allow sufficient recovery time between isolation and the induction of experimental interventions. This lag time unpredictably reduces the population of viable myocytes; this reduction may impact spontaneous [Ca 2⫹]i transients and contractile activity [59] that are affected by the density of viable myocytes [60 – 62]. In contrast, immortalized cells preclude animal use, are more economical, have predictable yields, have high-throughput capability, and are homogeneous. Depletion of GSH upon passage is remedied by the 3 to 4 day period between plating and experimentally appropriate confluency. HL-1s can be successfully restored from frozen cultures, allowing extended passage. As Claycomb and colleagues have described previously, HL-1 cells can be serially passaged while maintaining differentiated cardiomyocyte morphological, biochemical, and electrophysiological properties [28]. As we demonstrated previously, HL-1s possess functional delta-opioid receptors, the dominant opioid receptor sub-type in human myocardium [22]. 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